胃旁路术后患者非侵入性方法与肝活检相比如何？

Are Noninvasive Methods Comparable to Liver Biopsy in Postoperative Patients After Roux-en-Y Gastric Bypass?

机构信息

Digestive Surgery Department, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, Brazil.

Gastroenterology Department, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, Brazil.

出版信息

Obes Surg. 2020 Jul;30(7):2566-2571. doi: 10.1007/s11695-020-04513-4.

DOI:10.1007/s11695-020-04513-4

PMID:32124221

Abstract

INTRODUCTION

Transient tissue elastography (TTE) may estimate the degree of hepatic fibrosis in patients with obesity, but the method has restrictions that are mainly related to patients' BMI.

PURPOSE

To compare the results of the evaluation of hepatic fibrosis by biochemical methods and TTE with those determined by liver biopsy in patients after RYGB.

METHODS

This was a cross-sectional study involving patient data, TTE, and liver biopsy 1 year after RYGB.

RESULTS

Of the 94 selected patients, 33 underwent TTE and liver biopsy. The average weight of patients was 84.4 ± 15.4 kg. The mean APRI was 0.2 ± 0.1, and 36 patients (97.3%) were classified as F0-F1. The average NFS was - 2.0 ± 1.0, with 25 patients (67%) classified as F0-F1 and 12 patients (32.4%) classified as F2. The agreement rate between Fibroscan and liver biopsy was 80.0%. Histological analysis revealed regression of inflammatory changes in all patients: 26 patients (72.2%) had some degree of non-alcoholic steatohepatitis (NAS ≥ 5), and after surgery, no patient presented inflammation upon biopsy. Nine patients (24.3%) had fibrosis at surgery, and only two (5.4%) still had fibrosis 1 year later (p < 0.008).

CONCLUSIONS

The use of APRI and Fibroscan is promising, but more studies are needed to evaluate patients with an advanced degree of NAFLD and confirm the entire spectrum of the disease.

摘要

简介

瞬时弹性成像（TTE）可用于评估肥胖患者的肝纤维化程度，但该方法主要与患者 BMI 相关，存在一定局限性。

目的

比较 RYGB 术后患者生化方法和 TTE 评估肝纤维化与肝活检结果。

方法

这是一项回顾性研究，纳入了患者数据、TTE 和 RYGB 术后 1 年的肝活检。

结果

在 94 名入选患者中，有 33 名患者进行了 TTE 和肝活检。患者平均体重为 84.4±15.4kg。平均 APRI 为 0.2±0.1，36 名患者（97.3%）被归类为 F0-F1。平均 NFS 为-2.0±1.0，25 名患者（67%）被归类为 F0-F1，12 名患者（32.4%）被归类为 F2。Fibroscan 与肝活检的一致性率为 80.0%。组织学分析显示所有患者的炎症改变均有消退：26 名患者（72.2%）存在一定程度的非酒精性脂肪性肝炎（NAS≥5），术后活检均无炎症。9 名患者（24.3%）在手术时存在纤维化，仅 2 名（5.4%）在 1 年后仍存在纤维化（p<0.008）。